Motor, Visual-Spatial, and Somatosensory Skills After Closed Head Injury in Children and Adolescents: A Study of Change

Correlational studies of recovery of function following traumatic brain injury have revealed weak, nonspecific relationships between outcome and injury variables. In order to better identify factors affecting recovery, 49 children (aged 6-15 years) were followed prospectively with repeated neuropsychological assessment of motor, visual-spatial, and somatosensory skills up to 5 years postinjury. Analyses of individual growth curves revealed systematic nonlinear changes after injury. Variability among growth patterns related robustly to injury variables. Younger children with severe injuries showed slower growth on visual-spatia l and motor tasks than did older children of similar severity or similarly aged children with less severe injuries. These findings support a hypothesis of increased vulnerability of rapidly emerging skills in young children and argue against an explanation of lowered recovery rates due to concomitant maturational influences on development. Results of studies of cognitive functioning in children after closed head injury (CHI) have consistently demonstrated the presence of deficits in motor skills and nonverbal processing during the subacute phase of recovery (Klonoff, Low, & Clark, 1977; Levin & Eisenberg, 1979a, 1979b). These motor and nonverbal deficits persist one or more years postinjury (Chadwick, Rutter, Brown, Shaffer, & Traub, 1981; Knights et al., 1991; Winogron, Knights, & Bawden, 1984). Additional studies have demonstrated deficits in memory (Levin et al., 1988), language (Levin & Eisenberg, 1979a, 1979b), and behavioral adjustment (Fletcher, Ewing-Cobbs, Miner, Levin, & Eisenberg, 1990). Yet, few studies of neurobehavior al function in children after CHI have addressed changes in performance patterns over time or the actual process of change. To study the recovery process, researchers must use longitudinal measurement of specific abilities and behaviors. For instance, Chadwick, Rutter, Brown, Shaffer, and Traub (1981) prospectively studied the recovery of IQ scores in children up to 27 months after CHI. By testing the children